Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong.
Department of Psychiatry, Queen Mary Hospital, Hospital Authority, Hong Kong.
Eur Neuropsychopharmacol. 2021 Dec;53:79-88. doi: 10.1016/j.euroneuro.2021.08.263. Epub 2021 Sep 1.
Schizophrenia is associated with increased prevalence of diabetes. However, risk of diabetes complications as well as the impact of complication burden and patterns on subsequent mortality risk in schizophrenia patients with co-existing diabetes is understudied. This population-based, propensity-score matched (1:10) cohort study identified 6991 patients with incident diabetes and pre-existing schizophrenia and 68,682 patients with incident diabetes only (comparison group) between 2001 and 2016 in Hong Kong, using territory-wide medical-record database of public healthcare services. Complications were measured by Diabetes Complications Severity Index (DCSI), which stratified complication burden into 6 levels (DCSI score=0, 1, 2, 3, 4, or ≥5). Associations of diabetes complications, in terms of DCSI scores (complication burden), specific types and two-way combinations of complications (complication patterns), with all-cause mortality rate in schizophrenia were evaluated using Cox proportional-hazards models. Schizophrenia group had comparable macrovascular (adjusted OR 0.99 [95% CI 0.92-1.06]) and lower microvascular (0.79 [0.73-0.86]) complication rates relative to comparison group. Mortality risk ratio for schizophrenia was elevated at all complication burden levels, which conferred incremental impact on excess mortality in both groups. Cardiovascular diseases (1.60 [1.45-1.77]) and cerebrovascular-metabolic diseases (2.74 [1.25-5.99]) were associated with the highest differential mortality in schizophrenia among various specific complications and complication combinations, respectively. Our results indicate that schizophrenia patients with co-existing diabetes are at increased risk of excess mortality relative to those with diabetes alone, regardless of complication burden levels. Implementation of multilevel, targeted interventions is needed to improve diabetes-related outcomes and reduce mortality gap in this vulnerable population.
精神分裂症与糖尿病患病率增加有关。然而，合并糖尿病的精神分裂症患者的糖尿病并发症风险以及并发症负担和模式对随后死亡率的影响仍研究不足。本基于人群的、倾向评分匹配（1:10）队列研究在香港利用全港公共医疗服务的医疗记录数据库，于 2001 年至 2016 年期间确定了 6991 例患有新发糖尿病和先前存在精神分裂症的患者和 68682 例仅患有新发糖尿病的患者（对照组）。并发症通过糖尿病并发症严重程度指数（DCSI）来衡量，该指数将并发症负担分为 6 个等级（DCSI 评分=0、1、2、3、4 或≥5）。使用 Cox 比例风险模型评估了精神分裂症患者中糖尿病并发症（DCSI 评分）、特定类型和并发症的双向组合（并发症模式）与全因死亡率之间的关系。与对照组相比，精神分裂症组的大血管并发症（调整后的比值比 0.99 [95%置信区间 0.92-1.06]）和微血管并发症（0.79 [0.73-0.86]）发生率相当。所有并发症负担水平的精神分裂症死亡率风险比均升高，这对两组的超额死亡率均产生了增量影响。心血管疾病（1.60 [1.45-1.77]）和脑血管代谢疾病（2.74 [1.25-5.99]）分别与各种特定并发症和并发症组合中精神分裂症的最高差异死亡率相关。研究结果表明，与单纯患有糖尿病的患者相比，合并糖尿病的精神分裂症患者的超额死亡率风险增加，无论并发症负担水平如何。需要实施多层次、有针对性的干预措施，以改善糖尿病相关结局并缩小这一弱势群体的死亡率差距。
